Esperal for alcoholism: coding and side effects

"Esperal" is a toxic drug used in narcology to treat patients suffering from alcohol addiction. The active substance of this drug is disulfiram, which causes rejection of alcohol in any form, due to which a person develops an aversion to alcoholic beverages at a reflex level. At the moment, Esperal tablets are one of the main means of treating severe alcoholism.

Types of drug

The drug "Esperal" for alcoholism has three release forms:

1. tablets - one package contains 20 round white tablets with the engraving “ESPERAL” and a cross-shaped mark on the sides. One tablet contains 500 mg of disulfiram. A treatment regimen is selected individually for each patient, and the duration and specifics of the therapeutic course are determined;
2. capsules are special Esperal implants that are sewn under the skin. As a result, disulfiram accumulates in fatty tissues, from where it is gradually released and enters the bloodstream. Sewing in Esperal is considered more comfortable and effective, since, unlike oral therapy, there is no need for painful disulfiram-alcohol tests;
3. gel is disulfiram with a semi-liquid, viscous consistency, which is injected under the skin through an injection. Within two days, it is encapsulated and turns into the same full-fledged Esperal implant as capsules. The advantage of the gel is the absence of a tubercle that appears when the capsules are sewn in. In addition, there is no need to make incisions in the skin and monitor wound healing.

At the moment, only tablets are registered in the Russian drug register. "Esperal" gel and capsules are not sold in Russia, so for now this drug is used only for oral therapy.

Release form and packaging of Esperal tablets

Esperal tablets are produced in a box, inside of which there is a tube with the drug:

1. The box is cardboard, white.
2. The container with the medicine is made of polypropylene. The same white color as the box. The lid with a desiccant is equipped with a first opening control.
3. Tablets are milky in color with a slightly beige tint. Round, slightly convex on both sides. One has the inscription “ESPERAL”, and the other has cross notches. They have no smell. Quantity 20 pcs. in one bottle.

Instructions for use

The high toxicity of disulfiram causes a large number of contraindications, restrictions and precautions during treatment. All of them are described in detail in the instructions for use of Esperal. However, only a qualified narcologist can accurately determine whether such therapy can be prescribed to a particular patient, who will evaluate the patient’s medical history and the results of laboratory and physical examinations.

This is due to a wide list of absolute contraindications:

• standard: early age, pregnancy and lactation, individual hypersensitivity to the components of the drug;
• infectious and inflammatory processes in the acute phase, especially if they are localized in the brain and digestive organs;
• oncological processes;
• convulsive syndromes of any etiology;
• mental illnesses and central nervous system disorders;
• severe organ failure: cardiac, respiratory, liver and kidney;
• polyneuritis;
• diabetes.

Conditional contraindications of Esperal, when treatment is still possible, but should be carried out with caution, include:

• chronic diseases of the heart, kidneys and liver in remission;
• age over 60 years;
• residual manifestations of a previous heart attack;
• presence in the anamnesis of a record of the development of psychosis caused by previous use of disulfiram.

Also, the instructions for Esperal indicate that the active substance is poorly tolerated when taken simultaneously with various other drugs. Incompatible drugs can suppress or, conversely, enhance the effects of each other, leading to the development of overdose symptoms. There are cases where such combination therapies caused the development of bleeding, delirium, severe lethargy and an acute reaction to alcohol.

Esperal drug interactions

The simultaneous use of Esperal and isoniazid leads to disturbances in behavior and coordination.

The simultaneous use of the drug and 5-nitroimidazole derivatives - metronidazole, ornidazole, secnidazole, tinidazole - increases the risk of developing delirious disorders and confusion.

The combined use of Esperal and oral anticoagulants enhances their effect and increases the risk of bleeding.

Disulfiram is able to inhibit the oxidative metabolism of benzodiazepines, increasing their sedative effect (especially diazepam and chlordiazepoxide). Doses of benzodiazepines are recommended to be adjusted according to clinical symptoms.

Precautionary measures

Taking disulfiram is very dangerous because this active substance has hepatotoxic properties, which has a significant effect on the functional parameters of the liver. There are cases where such therapy led to hepatic coma with a fatal outcome. Therefore, to avoid the development of acute reactions, it is necessary to take some measures before starting treatment.

1. It is necessary to undergo a complete clinical examination, especially when assessing the level of liver transaminases. During therapy, you need to take a blood test for alkaline phosphatase, as well as the balance of aminotransferases AST/ALT at least once a month. If the AST/ALT level exceeds the norm by more than 3 times, the patient is stopped taking the pills and the Esperal implants are removed. In addition, detoxification therapy is urgently carried out to remove disulfiram from the body.
2. Disulfiram is also used for detoxification following nickel poisoning. But if eczema appears as a result of this, then the dosage of the drug is selected very carefully due to the high risk of developing hepatitis.
3. At first, treatment is carried out only in a hospital setting, so that narcologists can take urgent measures in the event of an acute reaction of the body to the drug.
4. You can start therapy only 3-4 days after the last use of alcoholic beverages. If a person is in a prolonged and severe binge, then detoxification is first carried out in order to completely remove residual products of ethanol breakdown from the body.
5. When combined with Esperal therapy with anticoagulants, every 2 weeks the patient must have blood donated to assess the coagulation index, since there is a risk of developing internal bleeding. The possibility of simultaneous use of different drugs with Esperal is determined by the doctor.
6. Disulfiram suppresses the activity of the central nervous system, therefore, during the entire treatment course, the patient’s memory, concentration and reaction speed decrease. It is prohibited to perform any responsible work under such conditions.

Esperal and alcohol should not be taken at the same time! Drinking 80 g of vodka leads to the development of pulmonary and cardiac collapse, and more than 150 g leads to death. Therefore, pills should never be given to a person secretly.

Drinking alcohol during treatment with the drug

Coding occupies a special place in the treatment of alcoholism.
Esperal, like its analogues, makes it almost impossible for the patient to drink alcohol, since the entry of ethanol into the body, even in the form of a medicine containing it, immediately provokes a whole range of unpleasant and dangerous reactions that worsen the well-being of the drunkard.

Therefore, after several such attempts, he develops a reaction of aversion to alcohol.

It can be used by an addiction treatment provider to apply other therapies while the drinker is abstaining from drinking, to solve the problem of alcoholism for good.

Hypnotherapy has proven itself well in the treatment of addictions, which treats by imposing a code or searching and replacing negative attitudes, thus solving the problem at a deep level.

The effectiveness of Esperal in complex therapy

The treatment of alcoholism should be approached comprehensively. Before prescribing treatment, the doctor must study the clinical picture of the disease and conduct an examination of the patient in order to determine the condition of his organs and systems.

Based on this, therapy is prescribed, the purpose of which is to both cleanse the body of toxins and prevent relapses of the disease. There are different ways to achieve a positive result.

One of the available medicinal methods for treating alcohol dependence is coding. Esperal is a drug that disrupts the breakdown process of ethyl alcohol in the body.

When drinking liquids containing alcohol, the patient feels so bad that he develops an aversion to alcohol. This is the therapeutic effect of this drug, which, in combination with other methods of treating this problem, shows excellent results, turning drinking into a disgusting activity for the patient.

Voluntary treatment scheme

Coding with Esperal by taking a course of pills turns out to be quite effective if the patient wants to overcome a bad habit. Therefore, if there is a conscious desire to quit drinking, the narcologist recommends the patient a short and humane treatment regimen. It takes 3–4 weeks, during which a physiological aversion to alcohol is developed. The tablets are prescribed in three stages of 7–10 days with a gradual dose reduction:

• I— 1 tablet (500 mg);
• II— ½ tablet (250 mg);
• III—¼ tablet (125 mg).

The recommended dose of the medicine should be taken once a day. Esperal is administered intravenously only through injections, but they are not sold in Russia.

An important point in such therapy is that the person himself understands that alcohol will harm him and cause a lot of unpleasant symptoms. Even in the event of a breakdown, it is not worth stopping the course, since the patient will feel all the painful consequences of simultaneous use of Esperal and alcohol. However, it is important that there are close people nearby who will not allow the consumption of lethal doses of ethanol and will call an ambulance in case of an acute reaction.

If there is a strong desire to stop drinking, the effectiveness of short therapy reaches 70%. But feasts and gatherings in company over a drink lead to breakdowns in half the cases. Therefore, many patients require several courses.

Pharmacological properties of the drug Esperal

Pharmacodynamics . Disulfiram inhibits the action of many enzymes. Inhibition of acetaldehyde dehydrogenase leads to an increase in the concentration of acetaldehyde, a metabolite of ethyl alcohol, which causes unpleasant symptoms: intense redness of the face, nausea, vomiting, discomfort, tachycardia and hypotension. Pharmacokinetics. When taken orally, disulfiram is rapidly but not completely absorbed (70–90%). It is rapidly metabolized: converted to diethyldithiocarbamate, which is then excreted in the form of a glucuronide or transformed into diethylamine and carbon disulfide. Some of the carbon disulfide is excreted by the lungs. The remaining portion is metabolized and excreted in the urine.

Compulsory treatment scheme

When a person is admitted to a drug treatment department due to prolonged binge drinking, alcoholic psychosis and delirium, compulsory therapy is necessary. It is often called three-stage, although in fact it consists of four periods:

• zero is a detoxification course that the patient needs to completely remove traces of long-term ethanol poisoning from the body. This period can take from 1 to 4 weeks;
• the first is the time when the patient is prescribed the maximum dose of disulfiram to quickly accumulate active substances in fatty tissues and increase its concentration in the bloodstream;
• the second is a key point in treatment, which involves alcohol provocations. Once every 3-5 days, under the supervision of a doctor, the patient is given a small amount of alcohol (usually vodka - up to 40 ml). Within 20 minutes, a pronounced aggressive reaction of the body to ethanol consumption should begin, accompanied by intoxication, headache, weakness, nausea and vomiting. Such disulfiram-alcohol tests are carried out so that the patient begins to perceive alcohol as poison on both a physiological and psychological level. They cause much more discomfort than short therapy and implantation of the Esperal drug, but the effectiveness of this scheme is higher;
• the third is the consolidation stage necessary to prevent breakdowns. In some patients, the craving for drinking has a powerful subconscious basis, which is extremely difficult to overcome. Disulfiram is gradually eliminated after cessation of therapy, so it will not cause unpleasant symptoms in the event of a breakdown. In order for a person to understand the dangers of drinking alcohol, taking Esperal in small doses should be continued for several years. It is assumed that during this time the patient will learn to live without alcohol.

During compulsory treatment, there is always a risk of an acute reaction in the form of systemic allergies, seizures and toxic poisoning. Therefore, disulfiram-alcohol tests are carried out only in a hospital setting.

However, long-term therapy with disulfiram at the third stage is not always possible, since after six months of taking the medicine, complications such as gastritis, hepatitis, thrombosis, polyneuritis and psychosis can develop. Therefore, the total duration of the course is determined according to indications.

Reviews about Esperal

Reviews of Esperal tablets indicate that patients who used them were able to give up alcohol during the period of treatment, and often adhere to a sober lifestyle after its completion. However, it should be noted that both the gel and the drug in tablet form actually cause a very strong negative reaction when taking alcohol, as evidenced by reviews. People who received sewing or injections noted a metallic taste in the mouth, periodic headaches, allergic reactions and other side effects. It is noted that even when drinking small doses of alcohol, side effects can be very serious.

Validity

The accumulation of disulfiram occurs within a week, although the maximum concentration of the active substance in the blood is recorded 12 hours after taking the tablet. The process of removing the drug takes up to 2 weeks. After this, the patient ceases to experience physiological aversion to alcohol, and all that remains is to rely on his conscious attitude towards his health.

If you sew in “Esperal” using capsules or gel, the average duration of the implant will be 5–7 months. If after this a person has a breakdown, then it is necessary to undergo oral therapy or take a new Esperal injection.

Contraindications

The following diseases and conditions are categorical contraindications to taking the drug:

• severe liver failure ;
• diabetes;
• epilepsy and seizures of any origin;
• mental illness;
• pregnancy and lactation;
• severe sensitivity to the components of the drug.

Relative contraindications are:

• hypothyroidism;
• renal failure.

Side effects

The development of side effects during treatment with Esperal is a common thing, but some of them are due to the properties of the drug itself, while others are due to the simultaneous intake of alcoholic beverages.

Alcohol compatibility

This medication is absolutely incompatible with alcohol. The coding procedure with this tool is based on the physical impossibility of drinking alcohol. A patient undergoing such therapy cannot drink alcohol without experiencing severe and sometimes dangerous symptoms of intoxication. If you still drink alcohol during treatment, this will lead to:

• depression or loss of consciousness up to the state of coma;
• respiratory failure – shortness of breath and increased breathing;
• myocardial infarction;
• cerebral edema;
• severe attacks of angina pectoris;
• heart rhythm disturbances;
• pulmonary edema;
• cramps.

Antidotes and neutralization

Patients suffering from alcohol addiction often behave unpredictably, and sometimes violently and aggressively. Some even require the narcologist to inject them with an antidote that will neutralize the effect of the encoding substance, especially if the person is not treated with the gradual oral regimen of Esperal, but has been implanted with Torpedo or another implant. In such cases, doctors usually give the patient a placebo in the form of saline solution or vitamins.

The existence of an antidote to disulfiram is a myth! No drug can quickly remove the active substance from the body.

Disulfiram accumulates in the subcutaneous fat layers, from where it is released gradually. Therefore, the only conditional antidote can be called methylene blue (1%). It does not accelerate the utilization of the active substance, but it relieves negative symptoms when an acute reaction to alcohol develops. Also for this purpose, the patient is given antihistamine, Diazepam and ascorbic acid.

In childhood

An absolute contraindication to the use of the product is children. Patients under 18 years of age are prohibited from using Esperal. This is due to the lack of clinical data on the effect of the drug on the children's body. Moreover, alcohol dependence is predominantly an adult disease. Even if a child suffers from it, he is prescribed other treatment methods.

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Price

Drugs for alcohol dependence: Teturam, Antabuse, Naltrexone, Medichronal, etc.

Unlike Esperal gel and injections, tablets can be bought at any pharmacy in the Russian Federation. The cost of one package varies between 1200–2300 rubles. Such a wide variation is due to markups in different networks, so the medicine will cost the cheapest in social pharmacies. But even the amount of 1,200 rubles is high for disulfiram and is due only to the foreign production of the drug. Its analogue “Teturam” for the same volume of active substance will cost a maximum of 400 rubles. However, the choice of medication is still an individual matter.

Price

When studying online pharmacy catalogs, you may notice some difference in the cost of the medicine. This is due to the many manufacturers and their own markups. It is worth remembering that you can buy Esperal only with a prescription from a doctor. This also applies to ordering medicine online. Approximate prices for this product are shown in the table:

If an alcoholic relapse occurs after treatment with Esperal

If a patient feels an obsessive desire to drink, a narcologist will definitely find an opportunity to dull his feeling and make abstinence more comfortable. But how to fight if the desire to drink does not go away, but only intensifies every day? Few people will be able to demonstrate such powerful willpower to resist such a desire. The patient does not want anything, neither eat nor drink, his thoughts are filled only with an obsessive desire to sip a glass of wine or a shot of vodka. If you try to imagine this situation in reality, it is enough to understand how an animal feels in a cage without water and food. If the patient's thirst for alcohol is not satisfied, this can lead to disastrous consequences. However, no one knows what this step will lead to - a slight deviation from treatment or a drunken relapse.

This is the main reason that the patient refuses treatment on his own, having never recovered from addiction. Despite the fact that he understands that he cannot drink alcohol and is aware of all the health risks, thirst nevertheless becomes the most important thing and puts an end to treatment. In such situations, when the desire to drink is just beginning to make itself felt, you need to seek help from a doctor as soon as possible, who can prescribe additional therapy aimed at reducing the desire to drink.

Indications for use

Gel "Esperal" is a modern development of a drug for the treatment of alcohol dependence. The method of its use can only be prescribed by a narcologist.

REFERENCE! Currently, compulsory treatment for alcoholism is prohibited, therefore, before treatment, the patient must sign a contract.

Treatment methods:

• Sewing a capsular gel implant under the scapula. The procedure is performed in a hospital under local anesthesia. The downside is that it leaves a scar at the sewing site. The advantage is that if the drug is poorly tolerated, the capsule can be removed.
• Gel intramuscular injection under the shoulder blade. It is carried out by a specialist narcologist in a hospital setting. Plus of the procedure: there are no scars left on the skin. The downside is that if it is poorly tolerated, serious medical intervention is needed to neutralize disulfiram and remove it from the body.
• Intravenous injection. Used for express treatment. The dosage is calculated strictly individually for each patient.

Esperal anti-alcohol tablets, instructions for which are usually included in the package, are taken according to certain rules in order to avoid possible negative effects or reduce the likelihood of their development. In most cases, the following simple three-step scheme is recommended:

• during the first 7 days, the alcoholic takes one tablet of the drug per day;
• in the second week of treatment, it is recommended to take half a tablet;
• the third week involves taking the drug in the amount of one-fourth of the entire tablet per day.

For alcoholism, Esperal is taken with meals to improve its main effects and smooth out possible negative effects. It is best to start the course under the supervision of professionals, so that doctors can promptly pay attention to the negative reaction of the body and stop it.

If a patient has a capsule with medicine sewn under his skin, he does not need to take pills following the indicated course. The medicine itself will gradually enter the blood, showing its basic properties.

Important! During treatment with Esperal, drops for alcoholism or other similar drugs are not taken so as not to provoke an overdose of the main active ingredient.

After the third week of treatment, the patient is recommended to conduct a small test regarding the effect of the drug under the supervision of a physician. This is done with an increased dose of medication and a small amount of alcohol. During the test, the body's reaction is noted and, if necessary, the person is recommended to either continue the course or increase the dose.

In most cases, an alcohol dependent person does not feel the presence of the drug in the body at all. The injection or incision site may make itself felt, but it goes away quickly. While going about your daily activities, you can easily forget about your treatment. The main thing is not to forget to take the tablets if you decide to use Esperal in this form.

The effect of disulfiram is fully manifested only after at least minimal amounts of ethanol enter the body.

Alcoholism among the population is not only a problem of the individual and his family, but also an undesirable phenomenon on a national scale.

Since it reduces the working capacity of the population and contributes to its disability, which is not beneficial for the state.

Therefore, the government allocates funds to finance medical institutions and programs that help addicted people cope with this problem.

There are many methods of combating alcoholism that doctors use in their work. One of them is coding, which has proven itself in the treatment of alcoholism.

Medicines that are used for this are sold in pharmacies with a prescription, since their uncontrolled use is unacceptable. The drug Esperal is an effective means of coding for alcoholism. It has been used in addiction medicine for a long time and there are many reviews from patients for whom it helped cope with the problem.

Indications for use

The drug Esperal was developed by doctors for the treatment of patients with chronic alcoholism to help them cope with cravings for alcohol. The specially engraved, cream-colored tablet is designed so that a person can simply split it to take the exact dosage prescribed by the doctor.

Contraindications to the binder for alcoholism

There is a whole list of diseases in which filing becomes too risky.

Before using this drug for coding against drunkenness, you need to carefully read the instructions and make sure that there are no following absolute contraindications:

• Disturbances in the functioning of the heart of various etiologies and vascular diseases.
• Diabetes mellitus at any stage.
• Kidney diseases, insufficiency of their function.
• Disorders of the nervous system and epileptic seizures.
• Pregnancy in women and lactation period.

Relative contraindications include renal failure and hypothyroidism. The possibility of suturing for these diseases should be discussed with your doctor.

The patient or his relatives should not make an independent decision about the possibility of treatment with Esperal. It is better to seek advice from a competent narcologist who will develop a comprehensive treatment regimen, taking into account the clinical picture and the individual characteristics of the patient’s body.

Alcoholism is a serious disease that is difficult to cure by relying only on taking pills. It is necessary to take care of cleansing the body of toxins, as well as psychological assistance to the patient, because addiction does not appear overnight, and there are deep subconscious reasons for addiction to alcohol.

Side effects from drinking during coding

Side effects from taking Esperal can include headaches, local allergic reactions, nausea and dizziness. The patient may have an unpleasant metallic taste in the mouth.

What awaits the patient after drinking a glass after treatment with Esperal?

As mentioned earlier, Esperal is designed to combat addiction to alcohol by creating an aversion to it. However, you need to understand that our mentality forces us to often act against the rules and go against the doctor’s instructions. In the event that a patient in the drug treatment department disobeys and drinks, the health consequences can be very diverse, including death. Whether or not it occurs will depend on a number of reasons:

• Blood alcohol level (how much you drank)
• Number of tablets or capsules taken

The development of complications occurs gradually, increasing proportionally as the level of alcohol in the blood increases. All drugs that work in this way have this effect.

As mentioned earlier, the narcologist conducts a visual test showing what exactly the patient will experience if abstinence is stopped. Moreover, loved ones are also allowed to see the Esperal effect with their own eyes. To do this, they are invited into the office and allowed to observe the patient’s health condition and the dynamics of its deterioration. This is necessary in order to recognize signs of intoxication in time and seek emergency medical help.

Thus, we can conclude that Esperal completely excludes the intake of alcohol-containing drinks. Esperal is able to overcome the physical craving for alcohol, but, unfortunately, it is not able to fight the root cause - the psychological craving. For this reason, Esperal is often used in combination to cover both components of the treatment.

Reviews about the medicine

Doctors

Irina Yurievna, narcologist

Esperal will help cope with addiction, but only if the rules of administration are followed and the dosage is adequately selected. It should also be taken into account that the negative effect does not develop to the required extent in all patients. The patient’s desire to quit the addiction is of great importance.

Alexandra Evgenievna, narcologist

Long-term remission when taking Esperal is achieved against the background of psychotherapy. A pronounced aversive effect helps overcome addiction. However, now the medicine is difficult to obtain in pharmacies.